Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | A89864 | CA |
NPI | 1053417808 |
---|---|
Provider Name | Elbert Kc Chang |
First Address | Montclair, CA 91763-2238 |
Second Address | Montclair, CA 91763-2238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 22/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A898640 | (05) | CA |
I24085 | (02) | CA |